REBEL EM

MAY 29, 2024

The idea behind abx is to prevent things like AOM and TSS but neither should be much of an issue with short term placement ICU Admission? Traditional teaching is that these patients are at risk for life-threatening bradydysrhythmias and should go to the ICU Literature here is non-existent. PMID: 7741333 Corrales CE, Goode RL.

ICU 102

ICU ALS ACS EMS 102

REBEL EM

FEBRUARY 19, 2024

PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? REBEL EM: Peripheral Vasopressors – Safe or Dangerous?

ICU 137

ICU EMS ALS OR 137

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 He was extubated and had normal neurologic function. He did well and was discharged. C), with Cardiac Echo -- A Pathognomonic ECG.

ICU 137

ICU OR ALS ED 137

EMOttawa

MARCH 14, 2024

1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1

Critical Care 140

Critical Care ICU 140

REBEL EM

FEBRUARY 8, 2024

PMID: 38215002 Clinical Question: In critically ill adults in the ICU is noninvasive blood pressure (NIBP) monitoring similar (≤10% difference) to invasive arterial blood pressure (IABP) monitoring? appeared first on REBEL EM - Emergency Medicine Blog. Paper: Haber, EN et al. J Intensive Care Med 2024. to 1.12; p = 0.03

ICU 123

ICU MICU ALS EMS 123

REBEL EM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. to 19.3hrs); Reduction by 3.6hrs ED LOS was shorter for the SQuID cohort ICU Admissions: SQuID & Traditional (Post Intervention): 42.9%

ICU 102

ICU ED ALS OR 102

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. What is ELECTRICAL ALTERNANS? I have excerpted below KEY facets to appreciate of this phenomenon.

ICU 130

ICU OR Defibrillator EMS 130

REBEL EM

APRIL 22, 2024

Population: Adult patients ( > 18 years of age) admitted to the ICU with COVID-19 and severe hypoxemia (defined as receiving supplemental O2 with a flow rate of at least 10L/min or receiving mechanical ventilation or non-invasive ventilation. appeared first on REBEL EM - Emergency Medicine Blog.

Life Support 74

Life Support ICU EMS OR 74

Broome Docs

JANUARY 27, 2025

Full blog post here. PMID: 39461792 Bottom line: The WOMAN 2 trial is a large double-blind RCT that shows no benefit of TXA in the prevention of postpartum hemorrhage, which fits with all of the existing literature demonstrating no role for TXA in the management of postpartum hemorrhage.

ED 101

ED OR ACS Critical Care 101

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). She was worked as a full code, and ROSC was achieved. Later the next day, she went into cardiac arrest again. She could not be resuscitated.

OR 122

OR STEMI ICU Coronary 122

REBEL EM

JULY 17, 2023

appeared first on REBEL EM - Emergency Medicine Blog. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4 Ketamine – A Systematic Review and Meta-Analysis Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami ) The post REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED?

ED 97

ED ICU Emergency Department Overdose 97

EMOttawa

JULY 18, 2024

It’s Backkkkk (Part 2) appeared first on EMOttawa Blog. In this post, we focus on management, the treatment of (strep) pharyngitis, and post-exposure prophylaxis. Take home #5: The four pillars of iGAS management […] The post Invasive Group A Strep (iGAS).

Critical Care 80

Critical Care ICU 80

Dr. Smith's ECG Blog

MAY 22, 2024

The patient stabilized and was transferred for ICU admission. Labs resulted, showing a potassium of 8.0 mEq/L, glucose of greater than 900 mg/dL, and anion gap metabolic acidosis consistent with DKA. He was discharged home several days later. Both together are VERY likely to be due to hyperkalemia.

Plasma 113

Plasma ICU OR 113

Dr. Smith's ECG Blog

JANUARY 9, 2024

The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. I have emphasized on many occasions in Dr. Smith's ECG Blog how AFlutter is by far (!) A bed side echocardiography revealed a severely depressed LVEF of about 20-25%. small squares in width (260ms).

Coronary 118

Coronary ACS ED OR 118

REBEL EM

APRIL 9, 2024

She’s helped to redesign the built environment of a Harvard ICU and an infectious diseases unit in Malawi. Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL EM Book Club – MicroSkills appeared first on REBEL EM - Emergency Medicine Blog. Post Peer Reviewed By: Salim R.

EMS 58

EMS ICU 58

EMOttawa

FEBRUARY 1, 2024

If you haven’t read part one – check it out here! […] The post Lung Protective Ventilation appeared first on EMOttawa Blog. In part two, we discuss lung protective ventilation and go through a few cases to help solidify what we’ve learned.

ED 81

ED Critical Care ICU 81

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

REBEL EM

NOVEMBER 6, 2023

So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups.

ICU 71

ICU Epinephrine ALS OR 71

Silk City Blog

FEBRUARY 24, 2022

The INSPIRATION Trial investigated outcomes with an intermediate vs. standard prophylactic dose of anticoagulation in ICU patients. However, there is no evidence to support the use of full dose anticoagulation in either the ICU or outpatient setting.

ICU 52

ICU OR 52

REBEL EM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

AUGUST 31, 2023

ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring. Median hemoglobin: 8.2

ICU 58

ICU ALS OR EMS 58

REBEL EM

JANUARY 9, 2024

appeared first on REBEL EM - Emergency Medicine Blog. Rezaie, MD (Twitter/X: @srrezaie ) The post Clinical Conundrums: Should You Give the First Dose of Antibiotics IV Before Discharging Home on Oral Antibiotics?

ALS 98

ALS ICU ED OR 98

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated. Case Continued: He was stabilized on more calcium, pressors, and high dose insulin.

Overdose 98

Overdose E-9-1-1 Coronary OR 98

REBEL EM

MARCH 23, 2023

The group that received phenobarbital had a higher maximum CIWA score than the group that received lorazepam, which could mean that phenobarbital was not as effective as lorazepam, although this is potentially confounded by patients who were transferred to the ICU were excluded from the study.

ICU 52

ICU Emergency Department ALS OR 52

Silk City Blog

JANUARY 20, 2022

The overall incidence of developing venous thromboembolism (VTE) is approximately 17% in patients diagnosed with COVID-19, with a significantly higher rate in the ICU setting (Jiménez 2021). Multiple studies have investigated the use of antithrombotic agents in patients with COVID-19 admitted to various hospital settings (Talasaz 2021).

ICU 52

ICU EMS 52

Dr. Smith's ECG Blog

JUNE 21, 2024

A patient in the ICU with significant underlying cardiac disease [HFrEF 30%, non-ischemic cardiomyopathy, LBBB s/p CRT-D (biventricular pacer), AVNRT s/p ablation a few yrs ago, hx sinus tachycardia while on max tolerated BB therapy] went into a regular wide-complex tachycardia after intubation for severe COPD exacerbation.

ICU 70

ICU OR 70

Dr. Smith's ECG Blog

JANUARY 3, 2020

The patient was admitted to the ICU. The potassium was repleted in the ICU to a total of 170 mEq with resolution of symptoms (this could be hazardous!). Large U-waves confirm the diagnosis of hypokalemic periodic paralysis (HPP). The K returned at 1.4 mEq/L and K was given po and IV. Mg was normal and phosphate was very low.

ICU 52

ICU EMS ED OR 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

I’m an avid reader of your blog, and wanted your valued opinion on this. He went into cardiogenic shock and is intubated in the cardiac ICU. Both the patient and his wife attributed it to spicy food a couple hours prior, and I had to talk him in to being transported.

Coronary 52

Coronary Paramedic ICU EMS 52

Dr. Smith's ECG Blog

MAY 8, 2014

He had a prolonged stay in the ICU requiring days of bicarbonate. Articles on TCA More TCA ECGs from Dr. Smith's ECG Blog More on TCA overdose, with ECGs, from life in the fast lane. He remained delirious and was given 3 mg of physostigmine (after pretreatment with 2 mg of lorazepam to prophylax against seizures).

Overdose 52

Overdose ICU EMS ED 52

REBEL EM

SEPTEMBER 29, 2022

Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial) appeared first on REBEL EM - Emergency Medicine Blog. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0 cc/kg/hour of LR Design: Multicenter, multinational, open-label, parallel-group, randomized, controlled, superiority trial.

ICU 52

ICU ALS Critical Care Emergency Department 52

EMDocs

FEBRUARY 9, 2024

Adapted from Dr. Smith’s EKG Blog. Source: [link] As you are calling the ICU and cardiology team, the patient has recurrence of her symptoms and repeat ECG shows return of the PVT. She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. She denies chest pain.

Defibrillator 98

Defibrillator OR ED ALS 98

REBEL EM

NOVEMBER 3, 2022

Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU. Rezaie, MD (Twitter: @srrezaie ) The post Etomidate Vs. Ketamine: A Systematic Review and Meta-Analysis appeared first on REBEL EM - Emergency Medicine Blog.

ALS 52

ALS ICU ED Emergency Department 52

REBEL EM

MAY 8, 2023

appeared first on REBEL EM - Emergency Medicine Blog. 2,230 records remained after the elimination of duplicates. 2,210 records were excluded after screening.

E-9-1-1 58

E-9-1-1 Critical Care ICU OR 58

Dr. Smith's ECG Blog

OCTOBER 19, 2022

Nevertheless, clinicians involved in emergency care will periodically encounter pacemaker issues — which underscores the importance of today's blog post. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings". For clarity — I've reproduced and labeled that tracing in Figure-1.

ED 52

ED ICU OR Emergency Department 52

Dr. Smith's ECG Blog

MARCH 12, 2018

This one is from a previous case on this blog, but is similar to this patient: This shows impressively obvious right heart strain. She had an uneventful ICU course and improved steadily over the course of a week. On initial exam she appeared acutely ill, with initial vitals showing tachycardia, hypoxia, and borderline hypotension.

ACS 40

ACS Coronary ALS ICU 40

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Rezaie, MD (Twitter: @srrezaie ) The post Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department appeared first on REBEL EM - Emergency Medicine Blog.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

in the ICU but survived with excellent function. As we have described multiple times on this blog, false positive "pericarditis" kills by distracting the clinician from actual emergencies including OMI, dissection, PE, and others. There is no reciprocal ST depression in ECG #1 ( other than the expected ST depression in lead aVR ).

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52